Steady Progress Against Breast Cancer

CHICAGO — The American Cancer Society, Illinois Division, applauds the Tribune`s recent coverage of issues surrounding breast cancer. Barbara Brotman`s March 3 story raises important questions about progress against the disease. Fortunately, we do have some of the answers.

U.S. breast cancer incidence has been increasing at a rate of 3 percent per year over the last decade. While a portion of this increase is due to progress in detecting tumors in earlier stages, early detection does not explain all of the increase.

High fat intake in women promotes excess estrogen production, and excess estrogen is linked to breast cancer. The average American woman derives nearly 40 percent of her calories from fat, which in turn increases her risk for developing breast cancer by as much as 30 percent. By contrast, women in Asian countries, who have diets that are very low in fat, have the lowest rates of breast cancer among the nations.

The U.S. breast cancer death rate has held steady even while incidence of the disease has spiraled. Refined use of mammography, chemotherapy, radiation and new treatments like tamoxifen and autologous bone marrow transplants have boosted the overall five-year breast cancer survival rate to 77 percent, up from 63 percent 30 years ago.

Today, the use of screening mammograms has made it possible for breast cancers to be detected literally years before they are palpable to a woman or her physician, when the survival rate approaches 100 percent. After a decade of intense mammography promotion, the American Cancer Society calculates that an additional 3,030 Illinois women are alive today because screening mammograms in the 1980s detected their cancers in the earliest stage (in situ).

Detection of breast cancer diagnosed in situ also allows a woman the breast-conserving option of lumpectomy, removal of the tumor and surrounding tissue rather than the entire breast.

Of course, the big question is: If all this progress against breast cancer is so, why will 46,000 U.S. women die of the disease this year?

Perhaps the most heart-breaking fact about breast cancer is that more than half of all the women who will succumb to it in 1992 could have been saved if American Cancer Society early detection guidelines had been followed. Our challenge is to provide universal access to lifesaving mammography. Currently, only one-third of U.S. women have mammograms in accordance with society guidelines.

We need to remove economic, social and cultural barriers to mammography. We also need to achieve universal physician support for regular mammograms for their patients. In addition, we must continue to raise public awareness about the benefits of mammography.

Over the past few years, American Cancer Society volunteers have successfully lobbied to remove barriers to mammography. Both Medicaid and private insurance in Illinois now are required by law to cover screening mammograms. The federal Medicare program also has begun to provide partial coverage.

Meanwhile, the American Cancer Society has initiated a mammography demonstration project for medically underserved communities on Chicago`s West Side and in southern Illinois, exploring new ways to remove cultural and socioeconomic barriers to this lifesaving X-ray.

None of this is to say we don`t need more research dollars. We do. Much of our progress to date has come from society-funded research. But in addition to more science, we also need better public policy to make proper use of the knowledge and advances we already have.